HomeMy WebLinkAboutPlg Permit 02-1094
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
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ZONING (office use)
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LEGAL DESCRIPTION (office use only) "
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Clc REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
OWNER
(Name)
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(Address)
(Contact Person) (lHl{ L
APPLICANT SIGNATURE ~:; tli~\
(Address)
APPLICANT
(Name)
(Address)
Quantity
Industrial, Commercial & M
Estimated Cost $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
(Phone) C{ C; ~- y \..\C ~ l \ S'L{
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(Phone) 0CS;}
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(City)
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(Zip Code)
(Phone)
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DATE
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Type of Fixture
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Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
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.50
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Paid lJ. . ___
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714